Systole and diastole are physical phenomena, but they’re also useful metaphors in my life.
The terms refer to the contraction and relaxation of the heart. Intensity and rest. Both are critical to life. You can’t have one without the other.
Things have felt a little crazy lately, which is why I’m extra-grateful for my diastole: the fact that I don’t see patients every day.
Whenever I talk to residents or early-career doctors, I give them this unsolicited advice: DO EVERYTHING YOU CAN TO AVOID SEEING PATIENTS FULL-TIME.
“Ah, another primary care doctor who doesn’t want to see patients,” a mom once said to me at the playground, when I told her about my schedule as a part-time clinician. She was a practice manager at a huge primary care clinic in Philly.
But do you know how contemporary corporate health care defines “full-time?” It’s unsustainable, packing over 100 patients in each week and making us primary care docs responsible for the acute medical questions, insurance demands, and paperwork for the 2,000 or so patients on our panels. This work — which can take several hours each day — we’re supposed to squeeze in to our “free time” between those twenty-minute appointments.
It’s a one-way ticket to Burnout, USA. It is a systemic problem that needs a systemic solution.
But to protect myself and my family — and, frankly, my patients — my personal band-aid is to see patients three days a week. I have an academic role at our medical school, directing the narrative medicine program and teaching writing classes. But even those clinical and academic roles are not considered “full-time.”
Whenever I talk to new graduates, I encourage them to negotiate jobs that involve some percentage of their time doing non-clinical work. (Teaching, research, administration, or just nothing — not working “full-time.”) It’s a diastole that makes the systole — the intense experience of modern primary care — possible.
Here’s how I spent a recent non-clinical workday.
6:00 am: Wake up. Hit snooze.
6:15 am: I actually get out of bed and make myself my one cup of pour-over coffee. It sounds fancy, but it really isn’t hard, and it prevents me from drinking too much coffee and messing up my sleep. I’ve been struggling to keep up high-intensity exercise lately, so I’ve been doing my best to follow my own advice (and the advice of Anna Maltby) and just phone it in. Over the last few weeks, walking on a treadmill at a high incline has gotten me sweating without feeling insurmountable.
8:30 am: I drive my kid the mile-long trip to daycare. We usually walk there on my non-clinical days when I don’t have to be at work at 7 or 8, but today I’m dropping off the car to get inspected afterwards.
I try to balance errands and writing on my non-clinical days — the former can feel all-consuming, and the latter requires periods of deep, uninterrupted thinking — and right now I’m in a period where I’ve over-scheduled myself, trying to take care of gazillions of tasks. After I turned in the first draft of my book back in April, I frantically scheduled all the meetings and appointments I had been putting off.
Except the joke’s on me — because I just got edits back on my book!
It was so exciting to hear what my editor thought. Unlike many writers I’ve talked to, I actually love being edited. (I’m not saying this to kiss my editor’s butt, I swear!) It feels like such a gift to have someone care enough about my writing to help me make it better.
10:00 am: I am recording a podcast from my home studio, aka the guest bedroom where I usually work. The host mispronounces my name and I correct him, several times. It’s taken me 40 years to gain the confidence to do this. (It rhymes with “Car-Ahh,” for the record.)
11:15 am: I get a call from the mechanic that the car is ready. Perfect timing — I won’t have to take an Uber to work. While I wait for them to bring my car out, I check my clinical inbox on my phone and address a few patient questions and concerns. I surreptitiously check to my phone to do this all day every day. Luckily, I work with a great team of nurses and medical assistants who all help out with this work.
12:00 pm: I head to our narrative medicine workshop at the medical school. They are lovely monthly meetings where we read poetry and do writing prompts in response. They’re truly a reminder that everyone’s experience is worthy of empathy.
Today, I am not running the workshop — we try to get students, doctors, nurses, and other staff to serve as facilitators — but I coordinate them. Unfortunately, today nobody shows up! I’ve gotten a thicker skin, over the years, about the rejection inherent in planning events like this, but it still stings. I eat pizza and get to have a nice long chat with the colleagues who run this program with me.
Share Your Doctor Friend by Mara Gordon
1:15 pm: I get ready to drive home and plan to take a phone call in the car. But the person I’m talking with is freaked out about whether or not it’s safe and she asks me to call her when I get home. I admit I make phone calls all the time while I’m driving — it’s such a tempting form of multitasking — but her response makes me start to wonder 1) if it’s truly safe and 2) if it’s fair to not give my full attention to the person I’m speaking with.
3:00 pm: I give a Zoom lecture online. As I get started, I have the sinking realization I’m a little under-prepared — I re-used slides from a similar talk I gave to a different audience, and this group is actually quite different. I muddle through, and we manage to have a good conversation, but it’s a humbling reminder that you always need to know your audience.
I have another lecture to give at 9 the next morning that I also have not fully prepared for. I plan to wake up at 5 the next day to prep. I’m not proud of it — it’s definitely not a badge of honor, it’s a sign of overcommitting and not the best time management.
4:30 pm: I walk the dog to clear my head, check my clinical inbox one last time, and I also call my mom to check in. My parents have been experiencing some medical problems, so I try to call daily and visit them at least twice a week. I’m grateful they live nearby.
I then walk to our neighborhood barber to meet my husband and son for my kid’s haircut! I had planned to take him myself because I love it and it is so gosh dern cute, but I realized that morning that I wouldn’t have enough time between the end of the lecture and the haircut.
I am chronically underestimating how long it takes to do things and get places. Luckily my husband — who, in many ways, is the default parent — can pick up our son and take him.
Thanks for reading Your Doctor Friend!
5:15 pm: Fresh haircut complete, and we head to the playground. I leave my phone at home, which I often try to do when I’m out and about in the neighborhood. We bump into some neighbors and I’m so proud of my kid for sharing his granola bar with a younger kid.
6:30 pm: Home, and I make us a dinner of nectarine, burrata, and arugula salad. I wish I could say we always eat like this, but our meal planning is pretty intermittent. We get really into it for a few weeks, and then get lazy and find ourselves eating frozen pizza and frozen peas and corn. (It could be worse!) This week is a successful meal planning week, and we are reaping the delicious benefits.
7:30 pm: Bath and bedtime for my kid. We’re reading the First Cat in Space books, which are clever and beautiful. He’s really into graphic novels these days!
8:30 pm: I mentally berate myself for having to get up early the next morning to prep for my lecture and for not finding time in my day to work on my book edits.
My loving husband talks me off the ledge and I make a plan to do two discrete things to deal with this overwhelm. 1) I will ask my editor for a later deadline to return the manuscript (she immediately responded that it was no problem) and 2) we decide to cancel a big international trip in favor of a vacation within driving distance. It’s a bittersweet decision — and a very privileged one — and I immediately feel relieved.
I finally get to my favorite part of the day: reading time! I’ve been reading several excellent books lately, since I try to keep different genres in different parts of the house.
In the bathroom, for reading during my kid’s bath: Having It All by Corinne Low.
And before bed: Kin by Tayari Jones. (And Famesick by Lena Dunham on audiobook, which is so good — I was a huge fan of Girls. Always critical to have books in all places, ready to go!)
Reading all this, I’m not totally sure my diastole was actually a true diastole! I’m always reminded of what a fine line it is between thriving on multiple projects that give me a sense of purpose and meaning — and hurtling towards burnout.
Please share in the comments: How do you walk that line? How do you know when you’re reaching your limit and need to pull back on commitments?
A few other interesting bits and bobs I’ve been reading:
Help! I’m being forced to intensively parent against my will. Or, Kerala Goodkin vs. her public pool.
A depressing health care article I almost didn’t read, but I’m glad I did.
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